A community-based exercise program to improve walking outcomes in patients with p

描述（由申请人提供）：本申请是为了响应NIH NHLBI K01指导职业发展奖，以促进生物医学研究的教师多样性（RFA-HL-12-030）。候选人：我是一名运动生理学家，是科罗拉多大学丹佛分校（UCD） Anschutz Medical Campus （AMC）心脏病学部第三年博士后。我目前通过NHLBI F32个人博士后奖学金获得资助，基于我的试点项目“外周动脉疾病患者血管内治疗后社区运动计划”，我还获得了科罗拉多州临床和转化科学研究所（CCTSI）的资助（项目支持）。我已经开始接受社区参与式研究（CBPR）方法的培训，以加强我提出的在社区环境中为PAD患者创建创新运动项目的研究议程。这是在我参加2010年在犹他州帕克城举办的体育活动和公共卫生从业人员（PAPH）课程时完成的。我还参加了科罗拉多社区参与培训项目，美洲印第安人赛道。作为切罗基部落的一名成员，我处于一个很好的位置，可以继续向独立研究者的身份前进，同时也可以根据我的传统和过去的培训为临床研究提供独特的视角。导师/环境：我的导师团队由PAD、CBPR方法学和建筑环境评估、心脏病学和动机性访谈方面的国家级研究专家组成。Judy Regensteiner博士是我的主要导师，她在PAD和糖尿病患者的运动训练以及指导初级教师方面有着丰富的经验。William Hiatt博士是PAD患者临床试验的领导者也是科罗拉多预防中心的主席该中心是一个临床试验设计研究组织。Deborah Main博士在社区卫生研究方面具有专门知识，并在提案的CBPR方法中发挥了关键作用。Ivan Casserly博士是一位学术心脏病专家，他是外周血管介入领域的领导者。他将提供他在PAD患者护理方面的专业知识，并帮助招募PAD患者加入我们的试验。Paul Cook博士是这个设计的动机性访谈方面的顾问。他发表了许多关于在不同患者群体中使用这种技术的出版物，并将帮助我继续进行动机访谈培训，以提高PAD患者在社区环境中对运动的接受和坚持。培训：我的计划是继续我在CBPR实践和动机访谈以及公共卫生方面的培训。这将通过参与社区和临床结果研究（例如，CCTSI和PAPH项目）的初级教师的地方和国家一级培训机会来完成。我预计在拟议的奖励期内完成公共卫生硕士学位，特别是在社区和行为健康集中。此外，我将在申请审查时完成公共卫生科学证书。研究：尽管外周动脉疾病（PAD）的监督锻炼计划非常有效，但很少有人能够成功地利用这些计划。阻碍

DESCRIPTION (provided by applicant): This application is in response to an NIH NHLBI K01 Mentored Career Development Award to Promote Faculty Diversity in Biomedical Research (RFA-HL-12-030). Candidate: I am an exercise physiologist and 3rd year postdoctoral fellow within the Division of Cardiology at the University of Colorado Denver (UCD) Anschutz Medical Campus (AMC). I am currently funded through an NHLBI F32 individual postdoctoral fellowship based on my pilot project titled "A community-based exercise program following endovascular therapy for patients with peripheral artery disease" for which I also received a Colorado Clinical and Translational Sciences Institute (CCTSI) grant (project support). I have begun the process of receiving training in community-based participatory research (CBPR) methods to enhance my proposed research agenda of creating innovative exercise programs in community settings for patients with PAD. This was accomplished when I attended the 2010 Physical Activity and Public Health Practitioners (PAPH) course held in Park City, UT. I also participated in the Colorado Immersion Training in Community Engagement program, American Indian track. As a Tribal member of the Cherokee Nation, I am in an excellent position to continuing moving toward independent investigator status while also providing a unique perspective to clinical research based on my heritage and past training. Mentors/Environment: My mentor team is composed of national level research experts in PAD, CBPR methodology and built environment evaluation, cardiology as well as motivational interviewing. Dr. Judy Regensteiner is my primary mentor and has extensive experience in exercise training for patients with PAD and diabetes as well as in mentoring junior faculty. Dr. William Hiatt is a leader in clinical trials for PAD patiets and is the President of the Colorado Prevention Center which is a clinical trial design research organization. Dr. Deborah Main has expertise in community-based health research and has played a critical role in the CBPR methods of the proposal. Dr. Ivan Casserly is an academic cardiologist who is a leader in the field of peripheral vascular intervention. He will provide his expertise with regard to PAD patient care as well as aid in recruitment of PAD patients into our trial. Dr. Paul Cook is a consultant on this proposal for the motivational interviewing aspects of the design. He has a number of publications in using this technique in a variety of patient populations and will aid me in my continued training in motivational interviewing to improve PAD patients' adoption and adherence to exercise in community settings. Training: My plans are to continue my training in CBPR practices and motivational interviewing as well as in public health. This will be accomplished by participating in local and national level training opportunities for junior faculty in community-based and clinical outcomes research (e.g., CCTSI and PAPH programs). I anticipate completing a Master of Public Health degree during the proposed award period, specifically in the Community and Behavioral Health concentration. Additionally, I will be completing a Certificate in Public Health Sciences at the time of this application review. Research: Although supervised exercise programs for peripheral arterial disease (PAD) are highly effective, few people are able to successfully utilize these programs. Barriers that prevent patients from adopting and adhering to supervised exercise programs include lack of insurance reimbursement for walking exercise and poor proximity to hospitals and clinics as external barriers. Community-based exercise programs for PAD have to date met with inconsistent results possibly due to lack of training and follow-up. Thus, more consistent and directed programs need to be established for exercise training programs based in community settings that incorporate the strengths of supervised programs but also remove the barriers associated with exercise in the community. Our pilot project used novel training, monitoring and coaching (TMC) components in community settings that have been implemented successfully in supervised settings. We also evaluated the local walking environment for each PAD patient prior to community-based exercise. However, our previous pilot methods were designed from the researcher perspective and did not formally engage the actual PAD patients to gain their perspective on how to create effective interventions. Research programs that involve community members in developing the intervention to be used in the community setting may: 1) highlight additional barriers to walking using experiential knowledge of patients and 2) improve compliance by adjusting exercise prescription components that patients may have previously resisted completing. Thus, our project will use CBPR practices in the early design phase of the intervention to improve our piloted TMC intervention components in an effort to increase PAD patients' exercise performance. In addition, evidence supports exercise based motivational interviewing as an effective communication strategy for providing directed resolutions to problems while exercising and may improve self-efficacy of PAD patients. Thus, the primary aim of the proposed study is to determine the effect of a community-based exercise program with training, monitoring and coaching (TMC) components that are enhanced by CBPR practices and motivational interviewing (TMC+) to improve peak walking time (PWT) in PAD patients, which is the primary outcome of the study. (End of Abstract)